lecture 3 continued: clinical uses of electrical sitmulation currents Flashcards
what are the 4 levels that changes in the physiologic functioning as electricity moves thru the body’s conductive medium
✧ Cellular
✧ Tissue
✧ Segmental ✧ Systemic
what is the physiologic response to electrical current at a cellular level (5)
• Excitation of nerve cells
• Changes in cell membrane permeability
• Protein synthesis
• Stimulation of fibroblasts
and osteoblasts
• Modification of microcirculation
what is the physiologic response to electrical current at a tissue level (3)
• Skeletal muscle contraction
• Smooth muscle contraction
• Tissue regeneration
• Modification of joint mobility
• Muscle pumping action to change circulation and lymphatic activity
• Alteration of the microvascular system not associated with muscle pumping
• Increased movement of charged proteins into the lymphatic channels
these are physcilogic response to electrical currents at which level
segmental
• Analgesic effects as endogenous pain suppressors are released and act at different levels to control pain
• Analgesic effects from the stimulation of certain neurotransmitters to control neural activity in the presence of pain stimuli
these are physiological responses to the electrical current at which level
systemic
what are the 6 types of electrical stimulation currents
-electrical stimulation (NMES, FES)
- russian currents
-interferential currents (IFC)
- high volt pulsed current
-Transcutaneous Electrical
Nerve Stimulation (TENS)
- low volt current (DC)
which electrical current has symmetric biphasic currents
TENS
which electrical stimulation has twin peak pulsed waveforms
high volt pulsed current
which type of electrical stimulation has pulsatile biphasic waveform (2k-10k HZ)
russian currents
what type of electrical stimulation is a pulsed waveform and single or multiple channel electrical simulators programmed in a synergistic sequence
Electrical stimulation (NMES, FES)
Clinically, “TENS” refers to ES applied for ___ ___
pain reflief
what are the stages someone goes to as u crank up the electrical simulation
sub sensory
sensory
motor
noxious
what clinical stimulation level is someone at if there is no nerve activation and no sensory awareness
sub sensory
what clinical simulation level is someone at if they feel tingling , prickling , or pine and needles or there is cutaneous A - beta nerve fiber activation
sensory
what clinical simulation level is someone at if there is
- strong parasthesia
-mm contraction
-A alpha never fiber activation
motor
what clinical stimulation level is it if
- strong uncomfortable parasthesia
-strong mm contraction
-sharp or burning pain sensation
- A delta and C fiber activation
noxious
what type of fiber is recruited first for voluntary motor level stimulation
1
what type of fiber is recruited first for an electrically induced motor level stimulation
2
what is The location of skin above the muscle in which an electrical pulse applied transcutaneously evokes a muscle twitch with the least injected current.
motor points
motor points is where the threshold is ___ for a given electrical input
low
___ ____ stimulation gives the best individual muscle contraction
motor point
what kind of waveform is a high volt current
Twin-peak monophasic pulsed waveforms
what are the 2 main uses for high volt currents
reducing edema and wound healing
what current is preferred over high volt current for pain control
IFC and TENS
what currents is the best for MM contraction
russians and NMES
what is a monopolar high volt application
2 unequal sized electrodes
where is the active and dispersive electrode places for a monopolar high volt current
active is the smaller one over the treatment site and dispersive is the larger one placed somewhere away from treatment site
when during the phases of healing is negative polarity and positive polarity for high voltage most effective
negative is most effective during the inflammatory phase of healing and postivie is most effective during the proliferation phase of healing
____ of the electrode attracts charged ion and promote faster healing
Polarity
does edema control what polarity for u use for high volt
negative
what is the frequency and intensity and treatment time for high volt edema control
f: 120 pps
I: 30-50V or 10% less than that needed to produce a visible mm contraction
TT: 30 min session
which electrical current Uses gate control theory, the descending control theory, and endogenous opiate pain control theory.
TENS (asymmetric biphasic current)
pulse amplitude is the same as what
intensity
pulse width is the same as what
duration
pulse frequency is the same as what
rate
conventional TENS is for ___ rate and ___ intensity (sensory level )
high and low
what is conventional TENS best for
acute pain
what theory does conventional TENS use and what does it stimulation
gate control theory - stimulates A-beta fibers
the acupuncture like TENS would be used at ___ rate and ___ intensity (___ level_
low rate nd high intensity at the motor level
what is acupuncture like TENS usually used for
chronic pain
what theory does acupuncture TENS use and what does it release
Descending Pain control Theory – release of enkephalin
what level of TENS is hyperstimulation analgesia
noxious level
what theory dies the noxious level of TENS use
Endogenous opiate pain control theory
which TENS units does high rate and high intensity for fast pain relief during prodcueure wound debridement with peripheral and central analgesia
brief intense
___ ____ is the most common conventional TENS
Asymmetrical biphasic
what is the following for conventional TENS
• Frequency:
• Duration:
• Intensity:
• Treatment time:
• Frequency: 80 - 125 pps
• Duration: 75 - 150 microseconds
• Intensity: Tolerable sensory stimulation
• Treatment time: until pain is no longer
what theory is • Increased activity of A-beta afferents triggers the release of enkephalin from interneurons in Substantia Gelatinosa (SG), which inhibit synaptic transmission to 2nd order neurons (transmission (T) cells) and block pain message ascending to the brain
the gate control theory
what is the frequency , duration , intensity , duty and treatment time for LOW frequency TENS ( Acupuncture like - motors level)
f: < 20 pps
D: 100-600 microseconds
I: high enough to elicit both a sensory and motor
Duty: 30-60s on , off time as needed
TT: 15-60 mins
where is Low-Frequency TENS (Acupuncture-like, motor-level)applied over
motor point
what is the Frequency, duration , intensity , duty and TT for Noxious level TENS
F: 1-5 pps
D: 100-1000 microseconds
I: high intensity to a noxious level (mm contraction is ok)
Duty: 30-45 secs , off time as needed
TT: until pain no longer there
where is Noxious-Level TENS applied over
trigger or acupuncture points
• Peripheral blockage and extra-segmental analgesia
• Stimulation of the small afferents (A-delta and C) can stimulate the release of endorphins, beta-endorphin and dynorphin
• Beta-endorphin is released by anterior pituitary gland and hypothalamus
• Prolonged electrical stimulation on acupuncture points triggers the release of beta-endorphin and dynorphin
that theory is this
Endogenous Opiate Pain Control Theory
what is the following for **brief intense TENS **
- Frequency:
- Duration:
- Intensity:
- Treatment time:
- Frequency: 100 pps
- Duration: 100 - 600 microseconds
- Intensity: Muscle fasciculation to sustained
muscle contraction - Treatment time: ~ 15 minute
what is the main thing brief intense TENS is used for
wound debridement
• Serotonergic efferents: A descending system from thalamus stimulates the periaquedutal gray and the raphe nucleus to activate enkephalin interneurons
• Serotonin suppresses the release of substance P by A-delta and C fibers • Enkephalin is released to block signal transmission of 2nd order neurons
(lateral spinothalamic tract)
• Noradrenergic pathways: projects from pons to dorsal horn
what theory is this
Descending Pain Control Theory:
Peripheral and Central Analgesia
what is the difference between NMES and TENS
-waveform
-pps
-duration
-channels
-output/ duty
- modulations
-timer
-NMES is sym or asym wave form and TENS is usually only 1
-fixed or few rate options (20-50pps) for NMES and for TENS rate options are 1-150pps
- NMES has a fixed pulse duration where TENS is variable pulse duration
- NMES is sim or alt channel activation and TENS is same to both channels
- NMES has duty cycle settings and TENS is a constant output
- NMES only has ramping modulations and TENS has rate&or duration &/or amplitude modulations
- NMES has a timer and TENS doesn’t
what do you use russian currents for
mm strenghtening and mm re-education
Should you substitute therapeutic exercise with Russian E-Stim?
no
what is the burst mode for russian currents
50% on/off
what are the advantages for russian currents
-high frequency currents reduce resistant to flow , making waveform comfortable enough to handle more
- as intensity increases more motor nerves are simulated increased the contraction
- as soon as a nerve repolarize it stimulated again , producing a current that will maximally summate mm contraction
what is interfernetial currents used for (IFC)
pian control and mm spasm
IFC prodocues ___ waves at ___ frequencies
sine
different
which currents for u cross two bipolar configurations
IFC
what is the Interferential Currents: Sweep mode
allows the frequencies of the current to be modulated , resulting in. a modulated beat frequency
what do u want to avoid with Interferential Currents: Sweep mode
accommodation by beat frequencies
which IFC mode can you Provide both high and low frequency stimulation within the
same treatment area
sweep
what does the Interferential Currents: Scan mode allow
allow the amplitude of the input currents to the modulated
if a patient has a poorly localized pain what does Interferential Currents: Scan mode do
moves forces around. while the treatment is taking place enlarging effective treatment area
how many electrodes is pre mod
only 2 pads
which current is there Two currents that are interfered within the device before delivering the current to the patient
Premodulated (Bipolar) Interferential Current
what is the biphasic pulse rate and duration for NMES or FES for mm reeducation and strengthening
pulse rate - 35-55 pps
Duration: 200-600 us
